Epilepsy Foundation of Northeastern NY

Epilepsy Foundation » Local Services » Epilepsy Foundation of Northeastern NY » Board of Directors Application 

Board of Directors Application

*Name:
*Address:
*City: State: *Zip:
Home Phone:
Occupation:
Employer:
Business Address:
*Email:
Work Phone: Fax:

Professional Affiliations:

Civic Affiliations:

Past/present board memberships:

Please indicate in your own words what your commitment to the organization will be:

How will this organization benefit from your involvement:

Please indicate the commitees you with to serve on:

Fundraising, Marketing, and Public Relations Long range planning and program
Nominating and Membership Finance and Personnel